Preserving Bone Density: The Key To Preventing Falls In Older Adults — Dr Lee Joon Kiong

Ageing leads to gradual degeneration or wear and tear of joint areas, causing degenerative joint disease or bone spur formation.

With ageing comes a decline in physical functions. Elderly people find their mobility and agility are no longer as effortless as they used to be, while significant deterioration in bone quality puts them at higher risk of injuries.

Ageing also leads to gradual degeneration or wear and tear of joint areas, causing degenerative joint disease or bone spur formation, which is why it’s common to see patients suffering from issues such as knee osteoarthritis in clinical settings.

It doesn’t stop at the knee though — degenerative joint diseases can target the cervical, and lumbar areas, as well as the hip joints, fingers, and more.

More caution is needed in day-to-day activities, especially since older adults, thanks to their heightened bone fragility, are more likely to suffer from issues such as fractures in the event of a fall.

Adding on to that, is the potential for further complex complications piling on to the initial injury, and further delaying the healing process. 

It is these risks which make comprehensive treatment and care from orthogeriatric services such an urgent need.

With that in mind, you don’t need to wait to be injured before seeking orthogeriatric services — instead, here’s a few reasons to consider preemptively making it a regular part of your life:   

Osteoporosis Has No Obvious Warning Signs

Reduced bone density or bone mass is one of the major health issues faced by the elderly as they age. Human bone mass increases with age after birth, reaching its peak around the age of 25, and gradually decreasing in old age.

Women in particular, are more susceptible to this, due to factors such as hormonal changes during menopause which result in compression fractures, or non-traumatic fractures, of the spine, such as kyphosis and loss of height.

As  osteoporosis itself does not have any glaringly obvious symptoms or warning signs — in fact, many elderly patients only realise that they suffer from osteoporosis after they fall victim to fragility fractures post-falling from a standing-height.

Lack Of Awareness

Another glaring issue is that the country is sorely lacking in bone health prevention and awareness, especially in comparison to European and American countries — osteoporosis does not even make the top ten list of diseases.

In general, people pay more attention to issues such as heart disease, diabetes, and hypertension, and mistakenly believe that osteoporosis is a natural part of the ageing process.

At the end of the day, we pay the price, as we end up underestimating the severity of bone disease. Meanwhile, an issue like a hip fracture in an elderly patient with osteoporosis becomes an even more complicated event, bringing about serious harm.

Approximately 25 per cent of elderly individuals die within one year due to hip fractures; another 50 per cent rely on canes or wheelchairs for mobility, while only 25 per cent regain mobility after recovery, without any dependence on aids.  

Timely Treatment Is Crucial To Reduce The Bed Rest Period

After experiencing a hip fracture, time is of essence == if not promptly treated, the fallout from the fracture could result in patients being put on prolonged bed rest.

Unfortunately, while vital for the recovery of the bone, prolonged bed rest comes with its own perils as many patients may die from the resultant complications, which include, but are not limited to, pneumonia, bacterial infections, urinary tract infections, and venous thrombosis.

Therefore, surgery should be performed as soon as possible after a fracture to allow patients to get out of bed and achieve mobility as soon as possible.

In the case of elderly patients, the principle of hip fracture treatment is to perform surgery within 48 hours of the fracture, if possible. This sense of urgency is heighted if the patient in question is already dealing with other underlying comorbidities, such as heart disease, hypertension, or diabetes, as any surgeries for the fracture may need to be delayed as they receive treatment for their medical conditions from internal medicine physicians first.

Once their condition stabilises, then, and only then, can fracture surgery be arranged.

Many assume that fractures in the elderly only require the care of orthopaedic surgeons. However, such surgeries should be jointly treated by geriatricians and orthopaedic surgeons to tailor the most appropriate treatment plan for the patient and minimise risks.

Currently, there are only a few hospitals in Malaysia that have orthogeriatrics services, with Beacon Hospital being one of them. The hospital established this clinical department in 2023, forming a multidisciplinary team comprising geriatricians, orthopaedic surgeons, dietitians, anaesthetists, and pharmacists.

However, many hospitals in our country do not have a geriatrics department, so it is up to orthopaedic surgeons and internal medicine specialists to co-manage these hip fracture cases.

Post-Surgery Prep

Many orthopaedic surgeons overlook osteoporosis in patients before and after surgery, leading to the possibility of recurrent falls. He believes that if patients’ bone density is increased and their bones become stronger, they will be less likely to fracture if they fall again in the future.

Even in knee joint replacement surgery to replace injured or worn-out knee joints, most patients can use the implanted artificial joints normally for 20 years or more.

If a patient has osteoporosis and the bone density is not strengthened after surgery, there may be an increased risk of fractures near the implanted artificial joint.

The bones may collapse or sink, making it impossible to support the artificial joint, resulting in the patient experiencing knee joint pain again.

There is also an increased risk of secondary fractures — instances where elderly individuals have previously fallen. but are still unaware that they have osteoporosis, potentially leading to similar incidents within the following year, such as falling while going to the toilet without turning on the lights, or due to poor vision.

Due to this, after the patient completes surgical treatment, it is crucial that doctors assess the patient’s risk of falling again, and take measures to reduce and prevent the risk to the greatest extent possible from aspects such as living environment and bone density.

So with all of these risks in mind, what can be done to improve bone density?

How To Track, Increase, And Maintain Bone Density

One of the simplest things elderly individuals facing osteoporosis can do is to begin treatment and daily life adjustments. Adequate intake of calcium (1200 mg) and vitamin D (1200 IU) through diet, moderate exposure to sunlight, and moderate exercise (such as brisk walking, tai chi, etc.) are all beneficial for bone density.

Another way of keeping track of your bone undergo bone density testing (DEXA/DXA) starting from the onset of menopause to detect bone loss in the body. Regular bone density checks are even more necessary if family members have a history of fractures or osteoporosis.

In clinical practice, medications used to treat osteoporosis can be classified into three main categories.

The first category of drugs aims to reduce bone loss; the second category of drugs focuses on increasing bone formation function while the third category of drugs has dual functionality; reducing bone loss at the same time enhancing bone formation.

Your doctor will select the most appropriate medication for your condition to treat your osteoporosis.

It is to address these gaps, as well as tackle the disease at the root that a group of orthopaedic surgeons, including myself, collectively worked together to establish the MyBONe Society (MyBONe Malaysian Bone Health Optimization Network).

Through the MyBONe society, we aim to advocate for the importance of treating osteoporosis to all orthopaedic doctors and promote responsibility in assessing bone health.

By promoting this concept, we hope to encourage every orthopaedic doctor to be more proactive in addressing and treating osteoporosis, thereby increasing the treatment rate and reducing the occurrence of fractures and secondary fractures.

Dr Lee Joon Kiong is a consultant orthopaedic and trauma surgeon at Beacon Hospital.

  • This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.

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